An unusual appearance of the post-pubertal Herlyn-Werner-Wunderlich syndrome with acute abdominal pain: A case report

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This case report describes a 13-year-old girl with Herlyn-Werner-Wunderlich syndrome and pyocolpus who was successfully managed via vaginal septum resection, drainage, and salpingectomy.

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This case report describes a 13-year-old girl with Herlyn-Werner-Wunderlich syndrome who presented with acute abdominal pain, fever, and pyocolpos resulting from an obstructed hemivagina and uterus didelphys. Surgical intervention involved resecting the vaginal septum to drain pus and performing a second laparotomy for appendectomy and salpingectomy due to severe adhesion and infection. The authors note that retrograde bleeding caused by the obstruction led to pelvic endometriosis, which was managed with postoperative contraceptive therapy to prevent progression. Relevance to endometriosis: The paper explicitly discusses endometriosis as a complication of Herlyn-Werner-Wunderlich syndrome, noting that obstructive anomalies cause retrograde bleeding that induces the condition in approximately 89% of cases.

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Abstract

BACKGROUND: Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital urogenital defect. It is detected by unilateral low vaginal obstruction, uterus didelphys, and ipsilateral kidney agenesis. It usually becomes apparent with pain, dysmenorrhea, and presence of a vaginal or pelvic mass. Purulent vaginal discharge may also happen rarely because of infective complications of the obstructed hemivagina. In this report, we describe a post-pubertal case with acute abdominal pain. CASE: The patient was a 13-yr-old girl who was referred to us with acute abdominal pain one year after the onset of her menarche. In the pelvic examination, we detected hematocolpos. Abdominopelvic-computed tomography scan confirmed the presence of mullerian duct anomalies with uterus didelphys. This case of HWW syndrome along with pyocolpus was managed by vaginal septum resection, drainage of pus, and salpingectomy. CONCLUSION: The symptoms of HWW syndrome should be monitored in early puberty to prevent more complications.
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Although dysmenorrhea is among girls in puberty, it is advised to follow-up acute dysmenorrhea soon to avoid further medical consequences.

Coi Statement

The authors report no conflicts of interest.

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europepmc
last seen: 2026-10-04T09:26:46.659050+00:00
pubmed
last seen: 2026-10-08T21:26:25.435920+00:00
unpaywall
last seen: 2026-05-21T05:10:58.409756+00:00
License: CC-BY-NC-4.0